The Importance of Interdisciplinary Collaboration in Supporting Independent DSMES Practices
Jul 8, 2026, 09:00 AM
By Nichole Lewis, RN, CDCES
Working as a diabetes care and education specialist (DCES) often means learning how to build a support system—not just for patients, but for yourself as a clinician. In many settings, especially underserved areas, it’s not uncommon to be the only diabetes care and education specialist on staff. That reality can feel isolating at times, but it also highlights just how essential it is to know what resources are available and how to use them effectively.
One of the biggest advantages in my role is being part of a Federally Qualified Health Center (FQHC) that truly prioritizes whole-person care. Having access to an integrated patient education department and a wide range of services makes a significant difference in how I’m able to support patients. Diabetes management doesn’t happen in a vacuum, and the ability to collaborate across disciplines allows for more realistic and sustainable care plans.
Mental health support is one of the most critical resources I rely on. Our team includes Behavioral Health Consultants, psychiatry services, and Drug and Alcohol Counselors. Many patients are navigating not only diabetes, but also depression, anxiety, trauma, or substance use disorders. Being able to connect them directly with qualified professionals helps address the root issues that often impact diabetes self-management. It also reinforces the idea that diabetes care is not just physical but also deeply emotional and psychological.
Care coordination services are another cornerstone of support. Case managers and enhanced care management teams help bridge the gap between clinical recommendations and real-life barriers. Whether it’s helping a patient apply for benefits, secure transportation or housing, or navigate insurance, these team members play a crucial role in making care accessible. As a CDCES, having this layer of support allows me to focus more deeply on education while knowing patients have the necessary help to address their social determinants of health.
I work alongside registered dietitians, participate in focused diabetes clinics with clinicians and a pharmacist, and encourage patients to engage in clinic-offered, peer-led support groups. These group settings can be incredibly powerful, which patients often learning as much from each other as they do from clinicians and hearing shared experiences reduces isolation and builds a sense of community that can motivate long-term change.
Pharmacy support is another invaluable resource. Having access to a clinical PharmD allows for real-time consultation on medication safety, dosing, and adjustments. As our program grows, our pharmacist is also becoming more involved in direct diabetes education, which strengthens the overall care team and ensures patients receive consistent and informed guidance.
Our patient education department offers a wide variety of programs that extend beyond traditional diabetes teaching. From smoking cessation and healthier living groups to mindful eating classes, chair stretch sessions, yoga, and community events. These offerings help patients engage with their health in a more holistic and approachable way. Programs like Cooking Matters, which we’ve offered in the past, bring practical, hands-on nutrition and meal preparation and cooking learning into the clinic setting, which is something many patients find especially valuable.
Beyond local resources, there are also a few excellent national tools that I frequently recommend:
- The American Diabetes Association offers the Diabetes Food Hub, which includes recipes, meal plans, grocery lists, and even cooking demonstrations. It’s a practical, user-friendly way to translate nutrition education into daily life.
- Project Power, also through the American Diabetes Association, is another standout. It’s a free, interactive program that provides access to a health coach, short educational videos, and tools for tracking food, weight, and physical activity. It also includes goal-setting features and a community forum, which can help patients stay engaged and accountable.
- For physical activity, the FitOn app is my favorite recommendation. It allows users to customize workouts based on time, intensity, equipment, and fitness level—making it accessible for beginners and experienced individuals alike.
- Technology also plays a role in simplifying day-to-day management. Apps like BolusCalc can help patients on multiple daily injections who need to count carbohydrates to calculate insulin doses based on their individualized settings. CalorieKing is another useful tool, offering reliable nutritional information that supports accurate carbohydrate counting.
- Cost, of course, remains a major barrier for many patients. That’s where tools like GoodRx, manufacturer coupons, and patient assistance programs become essential. Some companies, like Dexcom, also offer assistance programs to improve access to continuous glucose monitoring technology.
While not every CDCES across the country has access to the same level of on-site support, many of these national resources are widely available and can help fill gaps in care. Ultimately, being an effective CDCES, especially when working independently, means knowing where to turn, how to collaborate, and how to connect patients with the tools they need to succeed. Even when you’re the only one in your role, you’re never truly working alone.